[A case of Tsutsugamushi disease with multiple organ involvement].
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Adult↗
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[A case of Tsutsugamushi disease, occurring in the rural area of Tama, Tokyo].
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Humans↗
[Susceptibilities of recent clinical isolates of Rickettsia tsutsugamushi to chemotherapeutic agents in vitro].
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Anti-Bacterial Agents↗
[Antigenic types of Rickettsia tsutsugamushi isolated from patients with tsutsugamushi fever and their distribution in Miyazaki Prefecture].
Rickettsia tsutsugamushi (Rt) isolated from patients with tsutsugamushi fever were examined for their antigenicity. This was done by indirect immunofluorescence (IIF) with guinea pig antisera against three standard strains (Karp, Kato and Gilliam) and two local strains (Kawasaki and Kuroki) isolated in 1981, and with mouse monoclonal antibodies against the three standard strains. In the meantime, antibodies in sera from 317 out of 442 patients registered during 1985 to 1988 were titrated by IIF with those five Rt strains. 1) Local isolates, Kawasaki and Kuroki strains, reacted most effectively with the homologous antiserum, respectively, showing four fold lower IIF titers against the heterologous antisera. 2) Kawasaki strain reacted with none of the monoclonal antibodies, whereas Kuroki strain showed a slight reaction with anti-Karp and anti-Kato, but not anti-Gilliam, monoclonal antibodies. 3) Seventeen out of 27 strains isolated in 1985 resembled the Kawasaki strain in their reaction patterns with the antisera and monoclonal antibodies, and the other 10 strains showed reactivity similar to the Kuroki strain. 4) Sera of 233 (74%) out of 317 patients showed the highest antibody titers against the Kawasaki strain and 69 (22%) of 317 against the Kuroki strain. It is thus evident that Kawasaki and Kuroki strains are antigenically different from the standard strains, and Kawasaki and Kuroki strains also differ from each other. It is suggested that two antigenic types (Kawasaki and Kuroki) of Rt were distributed in Miyazaki Prefecture, Rt of the Kawasaki type slightly dominates Rt of the Kuroki type, and recent tsutsugamushi fever has been caused by either one or the other type of Rt.
Antigens, Bacterial↗
[The first case of tsutsugamushi disease in Ehime Prefecture].
The first case of tsutsugamushi disease in Ehime Prefecture was experienced in December 1987 with successful isolation of the causative agent. The patient was taken ill twelve days after infection. Immunofluorescent antibody tests using the isolate, Yamazaki strain, and Gilliam, Karp, Kato, Irie and Shimokoshi strains as antigens revealed that the specific antibodies against these antigens appeared and increased in the blood of the patient during the course of the disease. And the antibody titers to the Yamazaki antigen were the highest of these antigens. Agglutinin for Proteus OXK did not appear in the blood of the patient. The immunofluorescent antibody test using type-specific monoclonal antibodies to Gilliam, Karp, Kato, Irie and Shimokoshi strains and these five strains and the Yamazaki strain as antigens revealed that the Yamazaki strain was identified as Karp type of Rickettsia tsutsugamushi.
Adult↗
Lymphocyte subpopulations of peripheral blood in tsutsugamushi disease.
We examined lymphocyte subpopulations in the peripheral blood and serum concentrations of immunoglobulin (Ig) in 8 patients with tsutsugamushi disease. In 7 of the 8 cases, there was a 4-fold or greater increase in IgG and IgM antibody titers between the initial and convalescent serum specimens. In one case, there was no increase, but IgM antibodies were detected with diagnostically significant antibody titers. The percentages of CD8- and CD2-positive lymphocytes measured before treatment were found to be significantly higher than during the recovery stage of patients with tsutsugamushi disease. The CD4/CD8 ratio in the peripheral blood calculated before treatment was significantly lower than that during the recovery stage. Serum concentrations of IgG and IgM in patients during the recovery stage were significantly higher than pretreatment levels, respectively.
Adult↗
[The first case of tsutsugamushi disease in 20 years infected in a rural region of Osaka].
Recently cases of tsutsugamushi disease have been reported in various areas in Japan. We met a case infected in a rural area, Sennan of Osaka prefecture. The patient suffered from high fever, left axillary lymphadenitis. At his left elbow an eschar was detected, so tsutsugamushi disease was suspected, despite no rash nor CRP elevation. By indirect immunofluorescence (IF) method, the diagnosis was confirmed. At an early stage (the fifth day after onset) he was followed by probable DIC, remitted successfully by administration of minocycline. For 20 years tsutsugamushi disease has not been reported in Osaka prefecture. This case is the second one and the first child case in Wakayama prefecture. Epidemiologic assessments may need to be investigated in Osaka and Wakayama Prefecture.
Antibodies, Bacterial↗
[Clinical and etiological studies of tsutsugamushi disease in Miyazaki district--correlation of serological type of R. tsutsugamushi to clinical feature].
The correlation of pathogenic and immunologic characteristics of Rickettsia tsutsugamushi to clinical findings of patients with tsutsugamushi disease in Miyazaki was investigated. In two immunological types, Hirano type strains seemed to have higher virulence to mice than Irie from the findings during the course of infection and on autopsy. A strain of Hirano type was so virulent as to succumb to the infection. As to clinical findings, incidence of hepatomegaly was slightly higher in Hirano type patients than Irie, which is one of the signs in severe type tsutsugamushi disease. This was supported by the higher mean value and frequent appearance of abnormality in liver function test, sGOT, sGPT and LDH, in this type of patients.
Adolescent↗
[Studies on tsutsugamushi disease in Gifu prefecture. 4. Survey results in Ena and Takayama City, and the summary of the studies in the prefecture].
Investigations of trombiculid mites and Rickettsia tsutsugamushi in wild rodents were made in Ena (Nov. 1988) and Takayama (May 1989) City. In the former area where no patient has been reported so far, Leptotrombidium pallidum (63.9%) was most predominant and no L. scutellare was found. A Karp-related rickettsia (11.1%) was isolated from wild rodents and 30% of them had antibody to R. tsutsugamushi (anti-Karp was prominent). The latter area where patients were reported in spring as well as in autumn, L. pallidum (22.4%) was one of the dominant species in spring. Karp-related strains were isolated from 37.5% of wild rodents. And the antibody possession rate was 50.0%. These data reconfirmed our hypothesis that the majority of patients in autumn were infected by L. scutellare and a part by L. pallidum. In spring in Takayama area, the vector was L. pallidum which possessed Karp-related strain(s).
Animals↗
[The first two cases of tsutsugamushi disease found in Toshima Island, Tokyo Metropolis].
It has been known that tsutsugamushi disease, so-called "Shichito-fever", is widely spread among the Izu Islands, Tokyo Metropolis. The cases were reported in Oshima Island, Niijima Island, Shikine Island, Kozu Island, Miyake Island, Mikura Island, and Hachijo Island previously, although no case has been reported in Toshima Island. In this paper, we report the first two cases of tsutsugamushi disease found in Toshima Island in December 1988 and December 1989. The first case was a 73 year-old male and the second case was a 83 year-old female, respectively. Fever, erythema and eschar were observed in both cases, while lymphadenopathy and hepatosplenomegaly were not detected. After tetracycline was administered, the fever immediately went down and erythema gradually disappeared in both cases. Specific immunofluorescence tests demonstrated that IgG antibody titers rose against Karp, Gilliam and Kato strains, and that IgM antibody titers rose only against Gilliam strain in both cases. Therefore, Gilliam-like strain of Rickettsia tsutsugamushi may play an important role in Toshima Island.
Aged↗
[A case of tsutsugamushi disease in the urban area of Komatsu City].
Most of patients with tsutsugamushi disease are diagnosed by their clinical histories suggesting the opportunities of Rickettsia infection in a rural region. We reported a 76-year-old female patient, who was considered to be infected in her house in the urban area of Komatsu City. She has shown typical clinical manifestations of tsutsugamushi disease, and was remitted successfully by oral administration of minocycline. Although specific antibodies to Rickettsia tsutsugamushi could not be detected in her serum by the complement fixation (CF) method during her clinical course, their significant elevation was confirmed by the indirect immunofluorescence (IF) method.
Aged↗
[Tsutsugamushi disease found in Haruna District, Gunma Prefecture--evaluations of the clinical features and the outbreak pattern].
From November to December in 1990, 7 cases of tsutsugamushi disease were found first in the southern foot of Mt. Haruna of Gunma Pref., Japan. The present study was conducted to clarify the clinical features and the outbreak pattern of rickettsial infection in this area. All the patients consisting of 6 males and 1 female farmers were admitted to our hospital, complaining of high fever, chills and skin rash on 5-12 days after working in the field. Based on laboratory examinations and one (or two) typical eschar, a tentative diagnosis of tsutsugamushi disease was made and all patients became better soon after the therapy with intravenous administration of minocyclin (200 mg/day). The high titer of serum antibody to Karp type Rickettsia (Orientia?) tsustugamushi was detected by an immunoperoxidase test (IP) in most of the patients, and also a Karp-like strain was isolated from only one patient, probably due to low virulence to mice. The agricultural areas along the Agatuma and Nakuta rivers in the northern foot of Mt. Haruna have been well known as the most endemic foci of the disease in Gunma Pref. Nevertheless, it was suggested that outbreaks of the disease might be potentially wide-spread throughout this Pref., when the prevalences of the disease were evaluated as incidences to a hundred thousand inhabitants or adjusted by the density of agricultural populations of each administrative divisions. As most of the patients in Gunma Pref. have been officially reported in autumn, a statistical trial indicates that there is a significant correlation between the levels of temperature and outbreaks of the disease in autumn.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Epidemiology of Tsutsugamushi disease and typing of isolated Rickettsia in Chiba Prefecture].
In Chiba Prefecture, the first patient of Tsutsugamushi disease was found in the southern part in the 1950's, but after that no patient was detected until 1982. After 1982, patients have been noticed again, the number of patients has been increasing year by year. The number of serologically confirmed cases was 152 and 157 in 1989 and 1990, respectively with indirect immunofluorescence assay. About 90 percent of the patients were found in November and December, prevalently in the southern part of the prefecture. On the other hand, a few patients were found yearly in a harf of towns and villages in this prefecture. The number of isolated strains of Rickettsia tsutsugamushi from patients was 4, i.e., TR6030, TR6310, TR6311, and TR6324 in 1986 and 3, TR1811, TR1827 and TR1829, in 1991. Six isolates except TR6303 reacted with anti-Kawasaki monoclonal antibody but not with other strain specific monoclonal antibodies. Therefore, these 6 isolates were determined as Kawasaki type strain. An isolate. TR6303, reacted with anti-Kuroki monoclonal antibody at a titer of 1:2560 and anti-Karp monoclonal antibody at a titer of 1:320. This result suggested that the recent Tsutsugamushi disease is mostly caused by Kawasaki types in this prefecture.
Humans↗
[Five cases of tsutsugamushi disease].
We experienced 5 cases of tsutusgamushi disease from October to November 1993 at Hokusyo Central Hospital. All patients showed high fever, skin rash and eschar and four patients showed lymph node swelling. All cases were diagnosed serologically by indirect-immunofluorescence technique and treated with minocycline. In a survey of anti-Karp, Kato, Gilliam, Kawasaki, Kuroki antibodies, all patients showed the highest antibody titers against the Kawasaki strain and they were considered Kawasaki type. In Nagasaki Prefecture, the number of patients with tsutsugamushi disease has been increasing since 1982. We carried out immunologic and epidemiologic studies about this disease in Nagasaki Prefecture.
Adult↗
[A case of severe tsutsugamushi disease without eruption].
A 64-year-old male was admitted to our division because of fever. After admission, the patient was given beta-lactam antibiotics intravenously because he had no eruption and eschar. However, the fever continued, and he became unconsciousness and DIC appeared. We diagnosed the patient as Tsutsugamushi disease from indirect fluorescent antibody technique. Minocycline was excellently effective. Several reports of Tsutsugamushi disease without eruption have been given, so we must always be careful of Tsutsugamushi disease.
Antibodies, Bacterial↗
[Serotype-specific amplification of Rickettsia tsutsugamushi DNA from clinical specimens by nested polymerase chain reaction].
Polymerase chain reaction (PCR) with nested primer pairs was used to diagnose Tsutsugamushi disease and identify the Rickettsia tsutsugamushi serotype. The primer pairs used for PCR were designed on the basis of the nucleotide sequence of the gene that encodes the 56-kDa antigen. Five serovariants, the Gilliam, Karp, Kato, Kawasaki, and Kuroki strains of Rickettsia tsutsugamushi were detected and identified by nested PCR. The serotypes of patients registered during 1990 to 1992 in Kanagawa Prefecture were identified by nested PCR. Sixty percentage of patients showed Kawasaki types, 20% Karp types, and 20% Kuroki types. This result suggested that the recent Tsutsugamushi disease were mostly caused by Kawasaki types in Kanagawa Prefecture.
DNA Primers↗
[The use of polymerase chain reaction method for the detection of Rickettsia tsutsugamushi in wild rodents].
We studied the applicability of polymerase chain reaction (PCR) method for the detection of R. tsutsugamushi in wild rodents. The PCR method which amplified the gene coding for the group-specific antigen of R. tsutsugamushi was used in this study. Specific PCR products (88 bp) were obtained with the DNAs from three reference strains (Gilliam, Karp, and Kato) and two cell culture adapted field isolates (KN-1 and GJ-1). The minimum number detectable by the PCR method was estimated to be 1.3 copies of rickettsial genome. In a study with experimentally infected mice, the PCR method could detect rickettsial DNA in one of two infected mice at four months after inoculation. Thereafter, fifty five wild rodents were captured in five areas of Okayama Prefecture, and R. tsutsugamushi DNA was detected, by the PCR method, by amplifying DNA from the spleen of each rodent. The rickettsia was also isolated from the same rodents by the mouse inoculation method. By the PCR method, rickettsia DNAs could be detected in 12 of 13 rodents from which the rickettsiae were isolated, and in 10 of 42 rodents from which no rickettsiae were isolated. These findings indicate that the PCR method is a simple and specific procedure to detect R. tsutsugamushi in wild rodents. On the other hand, the results of the PCR method demonstrated that the middle area of Okayama Prefecture was highly (44-81%) contaminated with R. tsutsugamushi.
Animals↗
[Studies on tsutsugamushi disease in Gifu prefecture. 6. Correlation between number of patients and meteorological elements].
The correlations between numbers of tsutsugamushi disease patients and meteorological elements were analyzed for 11 years from 1982 to 1992 in Gifu Prefecture, Japan by using regression analysis. The number of patients in early winter was closely correlated independently to both the mean of the minimum temperatures from 11th May to 31st July and the mean of the maximum temperatures in November in the same year. Regression coefficients (R2) were 0.689 and 0.560, respectively. On this basis, an equation for prediction of the number of patients in early winter was designed as follows: N = [e (j - 17.6) + 2.3(v - 13)] x j x v/156 (prediction formula 1) N:predicted number of patients in early winter j:the mean of the minimum temperature from 11th May to 31st July v: the mean of the maximum temperature in November e:the base of the natural logarithm (= 2.718...) The number of patients in early winter was also closely correlated to j in an equation of the fifth degree (R2 = 0.930). N = 22.524656384 j5 - 2218.23705 j4 + 87272.992 j3 - 1714734.329 j2 + 16825634.235 j - 65963810.254 Based on these formulas, the temperature in early summer has a significant effect upon the prevalence of tsutsugamushi disease in early winter.
Humans↗